Sat May 06 2023

84 articles - From Saturday Apr 29 2023 to Saturday May 06 2023

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Guidelines

Guidelines and related publications, position statements, white papers, technical reviews, consensus statements, etc…

Gastrointest Endosc

Biliary and pancreatic stents.

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Summary: endoscopic therapies for walled-off necrosis.

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Meta-analysis

meta-analyses and systematic reviews

J Hepatol

An individual patient data meta-analysis to determine cut-offs for and confounders of NAFLD-fibrosis staging with magnetic resonance elastography.

MRE has excellent diagnostic performance for significant, advanced fibrosis and cirrhosis in patients with NAFLD. Elevated inflammatory activity and GGT level may lead to overestimation in staging early liver fibrosis, but anthropometric measures such as BMI or the degree of steatosis do not. Impact and implications This individual patient data meta-analysis on 8 international cohorts including 798 patients demonstrated that MRE achieves excellent diagnostic accuracy for significant, advanced fibrosis and cirrhosis in patients with NAFLD. The cut-off values (significant fibrosis 3.14 kPa, advanced fibrosis 3.53 kPa, cirrhosis 4.45 kPa) were established. Elevated inflammatory activity and GGT level may affect the diagnostic accuracy of MRE, overestimating liver fibrosis in early stages. No impact of diabetes, obesity or any other metabolic disorder on the diagnostic accuracy of MRE.

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TIPS prevents further decompensation and improves survival in patients with cirrhosis and portal hypertension in an individual patient data meta-analysis.

The use of TIPS for refractory ascites and for prevention of variceal rebleeding reduces the incidence of a further decompensation event in comparison to SOC and increases survival in highly selected patients. Impact and implication A further decompensation (new or worsening ascites, variceal bleeding or rebleeding, hepatic encephalopathy, jaundice, HRS-AKI and SBP) in patients with cirrhosis is associated with a poor prognosis. Besides the already known role of TIPS in portal hypertension related complications, this study shows that TIPS is also able to decrease the overall risk of a further decompensation compared to standard of care and increases survival. These results strengthen the role of TIPS in the management of patients with cirrhosis and portal hypertension related complications.

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Neurogastroenterol Motil

Experimental models of gut-first Parkinson's disease: A systematic review.

We have reviewed the details of these studies and present methodological considerations for the use of these models. Our aim is that this review will serve as a framework and useful reference for neuroscientists, gastroenterologists, and neurologists interested in applying their expertise to advancing our understanding of gut-first PD.

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Original articles

RCT, clinical trials, retrospective studies, etc…

Aliment Pharmacol Ther

Comparison of kidney function decline between chronic hepatitis B patients with or without antiviral therapy.

Compared with untreated patients, TAF or BSV users showed similar risk, whereas ETV users showed a higher risk of kidney function decline.

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Am J Gastroenterol

Correlation of internal jugular vein (IJV) collapsibility with central venous pressure (CVP) in patients with liver cirrhosis.

IJV CSA-CI at 30º correlated better with CVP (r=-0.56, P=<0.001), and an IJV AP-CI at 30º =24.8% was better at predicting a CVP =8 mmHg, with 100% sensitivity and 97.1% specificity. Thus, IJV POCUS might be superior than IVC POCUS as a predictor of CVP in cirrhotic patients.

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Growth Hormone Therapy in Decompensated Cirrhosis: An Open-Label, Randomized Control Trial.

Long-term use of GH is safe in DC and leads to improvement in malnutrition and possibly QOL. However, there is no improvement in 12-month survival. (NCT03420144).

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New therapeutic strategies are associated with a significant decrease in colectomy rate in pediatric ulcerative colitis.

In parallel with the increased use of IS and anti-TNF, an important decline in the risk of colectomy in pediatric-onset UC was observed at the population level.

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Pancreatic Cancer Screening for At-risk Individuals (Pancreas Scan Study): Yield, Harms and Outcomes from a Prospective Multi-Center Study.

Pancreatic cancer screening detected high-risk lesions with lower frequency than previously reported. No harms from screening were noted.

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Clin Gastroenterol Hepatol

Diagnostic Performance of Noninvasive Tests for Advanced Hepatic Fibrosis in Young Age Population.

The APRI showed better sensitivity and negative predictive value than the Fibrosis-4 index and the nonalcoholic fatty liver disease fibrosis score in community-based populations with mixed etiology, and, thus, can be performed as the primary test in young adults (age, =45 y).

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Statins are associated with a decreased risk of severe liver disease in individuals with non-cirrhotic chronic liver disease.

Among individuals with non-cirrhotic CLD, incident statin use was linked to lower rates of severe liver disease suggesting a potential disease modifying role.

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Endosc Int Open

Fatal outcomes of endoscopy: an analysis from the coroner's point of view.

Even in the thought-to-be-safe and screening endoscopic procedures fatalities do occur. This study gives an overview of endoscopy-related fatalities, stressing the role of ERCP, colonoscopy, and PEG.

Pubmed   Journal   ReadQx   PMC

Investigation of the efficacy of an innovative endoscope drying and storage method in a simulated ERCP setting.

The PlasmaTYPHOON is an effective fast-drying method capable of abolishing nearly al remaining microorganisms after decontamination provided no biofilm has developed, even when using a supraphysiological concentration of bacterial load. The clinical use of the PlasmaTYPHOON has the potential to reduce endoscope contamination, the use of wet contaminated endoscopes and therefore the risk of patient infection.

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Roux-en-Y gastric bypass pouch outlet reduction using argon plasma coagulation to treat weight regain: a randomized controlled trial with a sham control group.

This study indicates that APC outlet pouch reduction outperforms sham treatment in terms of weight loss for patients presenting weight regain after RYGB.

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Endoscopy

Endoscopic resection of early esophageal tumors in the context of cirrhosis or portal hypertension: a multicenter observational study.

In case of liver cirrhosis or portal hypertension, endoscopic resection of early esophageal neoplasia in patients appears to be effective and should be considered in expert centres with choice of resection technique following ESGE guidelines without undertreatment.

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Gastroenterology

Effect of Helicobacter pylori Eradication Therapy on the Incidence of Noncardia Gastric Adenocarcinoma in a Large Diverse Population in the United States.

In a large, diverse, community-based population, H. pylori eradication therapy was associated with a significantly reduced incidence of NCGA after 8 years compared with no treatment. The risk among treated individuals became lower than the general population after 7-10 years of follow-up. The findings support the potential for substantial gastric cancer prevention in the U.S. through H. pylori eradication.

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EUS - guided choledocho-duodenostomy using lumen apposing stent versus ERCP with covered metallic stents in patients with unresectable malignant distal biliary obstruction. A multi-center randomized controlled trial. (DRA-MBO trial).

Both procedures could be options for primary biliary drainage in unresectable MDBO. ECDS was associated with higher technical success and shorter procedural time then ERCP. Primary ECDS maybe preferred when difficult ERCPs are anticipated.

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Fibrosis Progression Rate in Biopsy-proven Nonalcoholic Fatty Liver Disease among People with Diabetes versus People without Diabetes: A Multicenter Study.

In this large, multicenter cohort study of well-characterized participants with NAFLD and paired liver biopsies, we demonstrate that fibrosis progresses faster in participants with T2DM compared to participants without T2DM. These data have important implications for clinical practice and trial design.

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Gastrointest Endosc

Gastric Peroral Endoscopic Myotomy for Management of Refractory Gastroparesis in Patients with Gastric Neurostimulator Devices: A Multicenter Retrospective Case Control Study.

Among patients with refractory symptoms after GNS, G-POEM can be a reasonable salvage therapy to provide further symptomatic relief with evidence of a potential additive effect of both G-POEM and GNS.

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Gut

Gut microbiome modulates the effects of a personalised postprandial-targeting (PPT) diet on cardiometabolic markers: a diet intervention in pre-diabetes.

Our findings support the role of gut microbiome in modulating the effects of dietary modifications on cardiometabolic outcomes, and advance the concept of precision nutrition strategies for reducing comorbidities in pre-diabetes.

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Hepatology

Bile exosomal miR-182/183-5p increases cholangiocarcinoma stemness and progression by targeting HPGD and increasing PGE2 generation.

CCA cells secret exosomal miR-182/183-5p into bile, which targets HPGD in CCA cells and MCs and increases PGE2 and VEGF-A release. PGE2 promotes stemness by activating PTGER1. Our results reveal a type of CCA self-driven progression dependent on bile exosomal miR-182/183-5p and MCs, which is a new interplay pattern of CCA and bile.

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Clinical trials reimagined.

The evolution of clinical trials will offer unique opportunities to advance new therapeutics that will ultimately improve the lives of patients with liver diseases.

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Extrachromosomal circular MiR-17-92 amplicon promotes hepatocellular carcinoma.

These findings delineate the genome-wide eccDNAs profiling of HCC and highlight the functional significance of microRNA-containing eccDNAs in tumorigenesis, providing insight into HCC pathogenesis and cancer therapy, as well as eccDNA and microRNA biology.

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Intratumoural microbial heterogeneity affected tumor immune microenvironment and determined clinical outcome of HBV-related hepatocellular carcinoma.

Microbiome-based molecular subtyping demonstrated IMH of HBV-related HCC was correlated with disparity in clinical-pathological features and tumor microenvironment, which might be proposed as a novel biomarker for prognosis prediction of HCC.

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Pathway to global elimination of hepatitis B: HBV cure is just the first step.

We present key actions required for successful HBV cure implementation, integrated within the WHO GHSS 2022-2030 framework. Finally, we highlight what can be done now to progress towards the 2030 HBV elimination targets using available tools to ensure we are preparing, but not waiting, for cure.

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Targeting hepatic serine-arginine protein kinase 2 ameliorates alcohol-associated liver disease by alternative splicing control of lipogenesis.

These studies reveal that 1) The regulation of alternative splicing by SRPK2 is implicated in lipogenesis in humans with ALD; 2) FGF21 is a key hepatokine that ameliorates ALD pathologies largely by inhibiting SRPK2; and 3) Targeting SRPK2 signaling by FGF21 may offer potential therapeutic approaches to combat ALD.

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J Hepatol

A 'one-stop-shop' point-of-care hepatitis C RNA testing intervention to enhance treatment uptake in a reception prison: the PIVOT study.

The 'one-stop-shop' intervention enhanced treatment uptake and reduced time to treatment initiation among people recently incarcerated in Australia, thereby overcoming key barriers to treatment scale-up in the prison sector. Impact and implications Prisons are key settings to focus HCV testing and treatment scale-up efforts, given the high HCV prevalence in the incarcerated population, and the ongoing incidence related to injecting drug use and lack of access to harm reduction. This study provides important insights for health service and policy makers regarding optimal HCV testing and treatment pathways for people newly incarcerated in prisons. The findings will improve health outcomes in people in prison with chronic HCV infection by increasing testing and treatment, thereby reducing infections, liver-related morbidity/mortality, and co-morbidities. The findings will change clinical practice, clinical guidelines, and international guidance, and will inform future research and national and regional strategies, in particular in regard to point-of-care testing which is rapidly being scaled-up in various settings globally. The economic impact will likely include health budget savings resulting from reduced negative health outcomes relating to HCV, and health systems efficiencies resulting from the introduction of simplified models of care. Efficient and effective interventions, such as the 'one-stop-shop' intervention in this study, will directly contribute to both National and the World Health Organisation targets for elimination of HCV by 2030, including increasing HCV diagnoses to 90% and treatment initiations to 80%. Clinicaltrials GOV NCT04809246.

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Bio-molecular map of albumin identifies signatures of severity and early mortality in Acute Liver Failure.

In ALF, the albumin is hyperoxidised and substantially dysfunctional. Our study outlines distinct 'albuminome' signatures capable of segregating ALF patients predisposed to early mortality or requiring emergency liver transplantation. Impacts and implication Here, we reported the bio-molecular MAP of albumin in Distinct and linked to severity and outcome in acute liver failure (ALF) patients. Detailed structural, functional and Albumin-omics analysis in ALF patients led to the identification and classification of albumin bound biomolecules which could segregate ALF patients predisposed to early mortality. More importantly we found albumin bound metabolites indicative of mitochondrial damage and hyper-inflammation as putative indicator of <30 days mortality in ALF patients. This preclinical study validates the utility of albuminome analysis for understanding the pathophysiology and development of poor outcome indicators in ALF patients.

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Comparison of HAV and HCV infections in vivo and in vitro reveals distinct patterns of innate immune evasion and activation.

HAV induces an innate immune response in hepatocytes via MDA5/LGP2, with limited control of both pathways by proteolytic cleavage. HCV activates TLR3 and lacks TRIF cleavage, suggesting that this pathway mainly contributes to HCV induced antiviral response in hepatocytes. Our results shed new light on induction and counteraction of innate immunity by HAV and HCV.

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Neurological worsening in Wilson Disease - Clinical classification and outcome.

This single center study postulates to distinguish early (=3 months) treatment associated from late NW (>12 months of treatment). Early paradoxical NW was attributed to treatment initiation and preexisting neurological damages, but was not observed in hepatic patients. Late NW is likely to be associated with non-adherence Despite limitations, this study defines the timing of NW, delivers important data for future studies and prevents inappropriate dose changes. Impact and implications In patients with Wilson disease, defined as an excess accumulation of copper which can damage the liver, brain and other vital organs, neurologic worsening can occur despite chelation therapy. The study identifies different patterns of 'early' ( 12 months) neurologic worsening in relation to initiation of chelation therapy and establishes possible causes and potential for reversibility. These data should be useful for counseling patients and optimal management of chelation therapy.

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No virologic resistance to bulevirtide monotherapy detected in patients through 24 weeks treatment in phase II and III clinical trials for chronic hepatitis delta.

No amino acid substitutions associated with reduced sensitivity to BLV monotherapy were detected at BL or WK24 in non-responders or the participant with VB after 24-week BLV treatment.

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Neurogastroenterol Motil

Development and modification of a dysphagia question prompt list to improve patient-physician communication: Incorporating both esophageal expert and patient perspectives.

Incorporating expert and patient perspectives, we developed a dysphagia-specific QPL to enhance patient-physician communication. Our study highlights importance of incorporating patient perspective when developing such a communication tool. Further studies will measure the impact of this communication tool on patient engagement.

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Exploring gastrointestinal health in MECP2 duplication syndrome.

Our study is the first in-depth investigation that characterizes gastrointestinal health in MDS and enumerates differences in gastrointestinal symptoms between MDS and RTT. Strategies to reduce gastrointestinal symptoms will alleviate caregiver burden in MDS. Further studies are needed to examine the mechanisms that cause gastrointestinal problems in MDS.

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Reviews&Editorials

Plenty of the editorials are available as full text through the publisher website using the provided link

Aliment Pharmacol Ther

Review article: Functional dyspepsia and pregnancy-Effects and management in a special population.

Overall, despite the paucity of knowledge of treating FD during pregnancy, providers can mitigate this uncertainty by planning ahead with the patient. Patients should ideally minimise treatment until after breastfeeding. However, interdisciplinary resources are available to ensure that minimal-risk interventions are maximised, while interventions with more risks, if necessary, are justifiable by both the patient and the care team. Future investigations should continue to elicit the mechanistic relationship between FD and pregnancy while cautiously expanding prospective research on promising and safe therapies in pregnant patients with pre-existing FD.

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Clin Gastroenterol Hepatol

Bleeding and Thrombotic Complications in Patients with Cirrhosis: A State of the Art Appraisal.

In the background of these concerns, several super-imposed and complicated conditions including infections and renal dysfunction should be taken into account. Inherited forms of thrombophilia in the setting of cirrhosis perhaps do not outweigh the thrombophilia inherent to liver disease but warrant further consideration.

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The Global Burden of Liver Disease.

On the other hand, the USA has the highest ALD-related HCC cases while India, USA and Thailand have the highest non-alcoholic steatohepatitis (NASH)-related HCC cases. Although the burden of CLD is increasing globally, regions of the world are impacted differently due to a number of sociodemographic-factors.

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Endosc Int Open

Endoscope reprocessing: How to perform an adequate air drying?

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Microbiological surveillance - where do we stand?

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Gastroenterology

Colorectal cancer subtyping with microbiome - A game changer for personalized medicine?

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Lynch syndrome: a single hereditary cancer syndrome or multiple syndromes defined by different mismatch repair genes?

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Miscellaneous

misc publications eg case reports, tools of the trade, images of the month, etc…

Am J Gastroenterol

Calendar of Courses, Symposiums and Conferences.

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Duodenal Biopsies: Individual or Multiple Samples?

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Individualized approach to the management of hilar cholangiocarcinoma: How we do it.

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Intrapancreatic Fat Deposition: Cause or Consequence of First Acute Pancreatitis Attack?

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Navigating the "Trough of Disillusionment" for CADe Polyp Detection: What Can We Learn About Negative AI Trials and the Physician-AI Hybrid?

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Response to Zhang et al.

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The future of colorectal cancer screening: a global perspective.

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The Neglected Portal Intrahepatic Shunts.

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Endosc Int Open

Safety of endoscopic ultrasound-guided tissue acquisition with uninterrupted direct oral anticoagulation in a swine model.

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Endoscopy

A novel cannula with a movable tip facilitates cannulation during endoscopic retrograde cholangiopancreatography in reconstructed intestinal tracts.

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Defect closure with endoscopic suturing improves endoscopic full-thickness resection of duodenal gastrointestinal stromal tumors.

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Effectiveness of endoscopic ultrasound-guided drainage procedure for symptomatic lymphocele.

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Endoscopic embolization of a refractory bronchobiliary fistula by endoscopic retrograde cholangiography using coils and Histoacryl.

Pubmed   Journal   ReadQx   PMC

Endoscopy E-Videos - recently published.

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Gel immersion radial incision and cutting for pancreaticojejunostomy anastomotic stricture.

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How should we evaluate the efficacy of endoscopic closure appropriately? A black box between interventions and outcomes.

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How trivial is lumen-apposing metal stent retrieval?

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Large pedunculated colorectal polyps: more than meets the eye.

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Peroral cholangioscopy-guided transpapillary gallbladder drainage and cholecystolithotomy in the treatment of acute cholecystitis and cholelithiasis.

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Rare complications related to lumen-apposing metal stent placement, successfully treated by endoscopic hand-suturing device.

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Segmental absence of the intestinal musculature in the stomach of an adult found during endoscopic submucosal dissection.

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The "echo-free space" technique: a safe and reliable method for endoscopic ultrasound scope insertion.

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Gastroenterology

Adeno-associated Virus 2 implicated in recent clusters of unexplained acute severe hepatitis in children.

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An Unusual Case of Diarrhea, Dysgeusia, Grainy and Nodular Mucosa.

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Genomic analysis of hair from celebrated Composer provides insight into Liver disease susceptibility.

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Intratumoral Malassezia globosa levels predict survival and therapeutic response to adjuvant chemotherapy in patients with pancreatic ductal adenocarcinoma.

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Multiple Hepatic Artery Pseudoaneurysms with Eosinophilia.

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Pharmacomicrobiomics in IBD: should we select treatments based on gut microbes?

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Gastrointest Endosc

A very rare case of isolated collagenous duodenitis.

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THE APPLICATION OF TEXTURE AND COLOR ENHANCED IMAGING FOR ENDOSCOPIC SUBMUCOSAL DISSECTION.

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UNRECOGNIZED CHRONIC GIARDIASIS DETECTED BY MOTORIZED SPIRAL ENTEROSCOPY: SEEING IS BELIEVING!

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Gut

Obesity promotes a leaky gut, inflammation and pre-diabetes by lowering gut microbiota that metabolise ethanolamine.

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Hepatology

Duration of type 2 diabetes and liver-related events in nonalcoholic fatty liver disease: A landmark analysis.

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Letter to the editor: Variability in serum creatinine is associated with waitlist and post-liver transplant mortality in patients with cirrhosis.

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Reply: Variability in serum creatinine is associated with waitlist and post-liver transplant mortality in patients with cirrhosis.

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The key role of hepatology providers in optimizing reproductive care in patients with liver disease: a call to action.

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J Hepatol

Kratom Induced Acute Liver Injury: A Case Study and the Importance of Herbal Supplement Regulation.

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Letters&Replies

Letters to the editors and authors’ replies

Clin Gastroenterol Hepatol

Population-attributable fractions of nonalcoholic fatty liver disease on all-cause and cause-specific mortality risk: how large is the impact?

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Gastroenterology

Atezolizumab plus bevacizumab in advanced HCC: efficacy in NASH-specific etiology.

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Gut

Basal levels of microbiota-driven subclinical inflammation are associated with anastomotic leak in patients with colorectal cancer.

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Connecting inflammatory bowel and neurodegenerative diseases: microRNAs as a shared therapeutic intervention.

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Revisiting the donor screening protocol of faecal microbiota transplantation (FMT): a systematic review.

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J Hepatol

Hospital HCV elimination in addition to universal precautions could reduce incidence and infection burden in Italy.

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